Exclusion or Termination From Medicare or Medicaid Programs Can Mean Professional Death

Tuesday, May 12, 2015

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Have you ever been arrested for a criminal offense? Have you ever had discipline on your license as a health professional? Have you ever been assessed a repayment or fine by the Medicare or Medicaid Programs? If so, then you may have also been terminated from or excluded from the federal Medicare Program or your state Medicaid Program.

Check the List.

To check if you are on the federal government's List of Excluded Individuals and Entities (LEIE), click here.

To see if you are on Florida's list of individuals and entities who have been terminated from Florida's Medicaid Program, click here.

To check for possible termination from any other state's Medicaid Program, you will have to access that state's Medicaid fraud website. This can be done by searching "[your state's name] Medicaid fraud terminated provider list." The results should include the link to the Medicaid fraud health care providers' list for your state. However, there are many states that do not maintain their own list or rely on the federal government's LEIE.

Ordinarily, a health care provider that is excluded from a state Medicaid Program is supposed to be excluded from the Medicare Program, and vise versa. However, a recent article on Reuters pointed out that 1,800 health care providers banned from the Medicare Program were still billing state Medicaid Programs in 2014. It also stated that the figures shown underestimated the number by thousands. To read the entire article, click here.

If you have ever been licensed in another state, you should check that state's list to make sure action hasn't been unknowingly taken against you.

If the health care provider is terminated by the state Medicaid Program, this is usually cause for termination of contracts with health insurers, termination of contracts with other health care businesses or individuals, and termination of hospitalclinical privileges.

Being terminated by the state Medicaid Program also causes exclusion from the federal Medicare Program. This causes the health care professional to be placed on the Office of the Inspector General's (OIG) (LEIE) and on the federal General Services Administration (GSA) Debarment List. You will not be able to be employed by or contract with anyone else who contracts with the government or receives government funds.

If you find yourself on a state's excluded or terminated list or if you find yourself on the federal LEIE, all is not lost. There are ways to become reinstated.

The passage of time with no further offenses or similar circumstances is one of the most important factors. Most states and the federal government have applications that can be completed to be reinstated. The (OIG) in Washington, D.C., controls the applications for removal from the Medicare excluded list.

In virtually all cases, if there has been an overpayment determined, a fine assessed or restitution ordered, this must be repaid (or a payment plan worked out) before an application for removal of the exclusion will be favorably considered. Proving that you have not been working for or as a Medicaid or Medicare provider while you were excluded is usually required. Establishing that you do not intend to work in the health industry again may also be received favorably. Obtaining letters, certificates, testimonials and other documentation showing that you have been rehabilitated or that you are making a positive contribution to the community is also helpful.

Since putting together such applications with all of the required documentation is not a simple task, we recommend that you retain legal counsel experienced in such matters.

Comments?

Have you ever been added to the OIG's exclusion list? Did you know you could fight the allegations? Did you get reinstated? Please leave any thoughtful comments below.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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